Acute limb ischemia: contemporary approach

Fukuda, Ikuo; Chiyoya, Mari; Taniguchi, Satoshi; Fukuda, Wakako

doi:10.1007/s11748-015-0574-3

Cited by 32 publications

(23 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Due to the swelling of the musculature, arterial vessels are compressed and react to this additional mechanical irritation with a pronounced vasospasm. In such a situation, surgical pressure release via the incision of the fascia may relieve the tissue pressure and drain the edema [ 42 ]. In order to protect blood vessels from thrombosis, occlusions, and dangerous intraluminal pressure levels, a number of antithrombotic factors is expressed by the healthy endothelium.…”

Section: Edemamentioning

confidence: 99%

Acute Limb Ischemia—Much More Than Just a Lack of Oxygen

Simon

Oberhuber

Floros

et al. 2018

IJMS

View full text Add to dashboard Cite

Acute ischemia of an extremity occurs in several stages, a lack of oxygen being the primary contributor of the event. Although underlying patho-mechanisms are similar, it is important to determine whether it is an acute or chronic event. Healthy tissue does not contain enlarged collaterals, which are formed in chronically malperfused tissue and can maintain a minimum supply despite occlusion. The underlying processes for enhanced collateral blood flow are sprouting vessels from pre-existing vessels (via angiogenesis) and a lumen extension of arterioles (via arteriogenesis). While disturbed flow patterns with associated local low shear stress upregulate angiogenesis promoting genes, elevated shear stress may trigger arteriogenesis due to increased blood volume. In case of an acute ischemia, especially during the reperfusion phase, fluid transfer occurs into the tissue while the vascular bed is simultaneously reduced and no longer reacts to vaso-relaxing factors such as nitric oxide. This process results in an exacerbative cycle, in which increased peripheral resistance leads to an additional lack of oxygen. This whole process is accompanied by an inundation of inflammatory cells, which amplify the inflammatory response by cytokine release. However, an extremity is an individual-specific composition of different tissues, so these processes may vary dramatically between patients. The image is more uniform when broken down to the single cell stage. Because each cell is dependent on energy produced from aerobic respiration, an event of acute hypoxia can be a life-threatening situation. Aerobic processes responsible for yielding adenosine triphosphate (ATP), such as the electron transport chain and oxidative phosphorylation in the mitochondria, suffer first, thus disrupting the integrity of cellular respiration. One consequence of this is irreparable damage of the cell membrane due to an imbalance of electrolytes. The eventual increase in net fluid influx associated with a decrease in intracellular pH is considered an end-stage event. Due to the lack of ATP, individual cell organelles can no longer sustain their activity, thus initiating the cascade pathways of apoptosis via the release of cytokines such as the BCL2 associated X protein (BAX). As ischemia may lead to direct necrosis, inflammatory processes are further aggravated. In the case of reperfusion, the flow of nascent oxygen will cause additional damage to the cell, further initiating apoptosis in additional surrounding cells. In particular, free oxygen radicals are formed, causing severe damage to cell membranes and desoxyribonucleic acid (DNA). However, the increased tissue stress caused by this process may be transient, as radical scavengers may attenuate the damage. Taking the above into final consideration, it is clearly elucidated that acute ischemia and subsequent reperfusion is a process that leads to acute tissue damage combined with end-organ loss of function, a condition that is difficult to counteract.

show abstract

Section: Edemamentioning

confidence: 99%

Acute Limb Ischemia—Much More Than Just a Lack of Oxygen

Simon

Oberhuber

Floros

et al. 2018

IJMS

View full text Add to dashboard Cite

show abstract

“…Embolism recurs in 6-45 %. Therefore, anticoagulation is important to prevent recurrence [4]. Anticoagulation leads to a reduction in the propagation of the thrombus and accumulation of free-floating thrombus formations.…”

Section: Results and Conclusionmentioning

confidence: 99%

“…If no bypass is required, the arteriotomy should be closed using a vein patch to minimize potential stenosis [8]. Factors related to a successful outcome of the treatment of arterial embolism are an intact arterial intima, non-adherence of the thromboembolism to the intima, and a patent run-off vessel prior to embolization [4]. The catheter is introduced and pushed proximally beyond the thrombus and extracted after inflation of the balloon.…”

Section: Surgical Revascularizationmentioning

confidence: 99%

Current Treatment Options in Acute Limb Ischemia

Fluck

Augustin

Bley

et al. 2019

Fortschr Röntgenstr

View full text Add to dashboard Cite

Background Acute limb ischemia represents a clinical emergency with eventual limb loss and life-threatening consequences. It is characterized by a sudden decrease in limb perfusion. Acute ischemia is defined as a duration of symptoms for less than 14 days. Aging of the population increases the prevalence of acute limb ischemia. The two principal etiologies are arterial embolism and in situ thrombosis of an atherosclerotic artery. Immediate diagnosis, accurate assessment and urgent intervention when needed are crucial to save the limb and to prevent a major amputation. Delay in diagnosis and therapy may lead to irreversible ischemic damage. Method To assess the current treatment options in acute limb ischemia, this review is based on a selective literature search in PubMed representing the current state of research. Results and Conclusion Patients with acute limb ischemia should receive immediate anticoagulation. Treatment depends on the classification based on the degree of ischemia and limb viability. Especially acute (< 14 days symptom duration) Rutherford Categories IIa and IIb with marginally and immediately threatened limbs require definitive therapeutic intervention and are salvageable, if promptly revascularized. The current literature suggests that open surgical revascularization is more time effective then catheter-directed thrombolysis. However, with the advent of thrombolytic delivery systems and mechanical thrombectomy devices, treatment time can be minimized and successful utilization in patients with Category IIb (Rutherford Classification for Acute Limb Ischemia) has been reported with promising limb-salvage and survival rates. Large randomized studies are still missing, and guidelines suggest choosing the method of revascularization depending on anatomic location, etiology, and local practice patterns, with the time to restore the blood flow being an important factor to consider. Key points: Citation Format

show abstract

“…Hepatic active response is a predictable reaction, which belongs to the multiply organ failure syndrome. Association of IRI as the cause of such pathological effect in the organism was proved by a couple of researchers [32][33][34][35][36].…”

Section: Discussionmentioning

confidence: 99%

Antioxidant Enzymes Activity in Experimental Ischemia-Reperfusion Injury

Volotovska

Kashchak

2019

IJMMR

View full text Add to dashboard Cite

Background. Blood loss during civil and military limb trauma is the most common cause of preventable death. Complications due to the use of a hemostatic tourniquet are widely investigated nowadays. Therefore, the standards of the past have to be improved. Objective. The aim of the research is to study the reaction of the enzyme chain of the liver antioxidant system in the presence of modifications of ischemia-reperfusion injury (IRI). Methods. 210 white male-rats, aged 5-5.5 months, were used in the research. The dynamics of antioxidant enzymes activity catalase (Cat) and superoxide dismutase (SOD) in liver tissue in cases of modifications of ischemia-reperfusion injury (IRI) were studied. The period of investigation was in 24 hours, 3, 7, 14 days after the injury. Results. In cases of simulated IRI the catalase level mainly decreased at each period of the experiment. The peak of SOD activity was evidenced on the 1st, 3rd or 7th days after the experimental IRI according to the degree of trauma severity. Thus, IRI combined with severe blood loss and mechanical trauma caused the severest affection of the antioxidant system. Even a single application of hemostatic tourniquet caused similar wavelike reactions at different times. Conclusions. The development of IRI is accompanied by a significant depression of the liver antioxidant system. The most significant changes were evidenced in cases of IRI combined with blood loss and mechanical trauma, but even a single application of a tourniquet caused active response of the antioxidant enzymes.

show abstract

Acute limb ischemia: contemporary approach

Cited by 32 publications

References 29 publications

Acute Limb Ischemia—Much More Than Just a Lack of Oxygen

Acute Limb Ischemia—Much More Than Just a Lack of Oxygen

Current Treatment Options in Acute Limb Ischemia

Antioxidant Enzymes Activity in Experimental Ischemia-Reperfusion Injury

Contact Info

Product

Resources

About